﻿<div id="main_content">
<div class="login_content">
      <div class="form_title">ĐĂNG KÝ THÀNH VIÊN</div>
	  <div class="form_content">
		<form id="signup-form" action="process_signup.php" method="post">
			<fieldset>
			<legend>Thông Tin Đăng Nhập</legend>
			<table border="0">
				<tr>
					<td>
						Tên đăng nhập:
					</td>
					<td>
						<input type="text" id="txt_username" name="txt_username">
					</td>
				</tr>
				<tr>
					<td>
						Mật khẩu:
					</td>
					<td>
						<input type="password" id="txt_password" name="txt_password">
					</td>
				</tr>
				<tr>
					<td>
						Xác nhận mật khẩu:
					</td>
					<td>
						<input type="password" id="txt_repassword" name="txt_repassword">
					</td>
				</tr>
			</table>
			</fieldset>
			<fieldset>
			<legend>Thông Tin Liên Hệ</legend>
			<table border="0">
				<tr>
					<td>
						Địa chỉ:
					</td>
					<td>
						<input type="text" id="txt_address" name="txt_address">
					</td>
				</tr>
				<tr>
					<td>
					</td>
					<td>
						Tỉnh:
						<select id="list_provinces" name="list_provinces">
                        <?php
                        include_once("includes/province.php");
                        $provinces = getAllProvince();
                        foreach ($provinces as $province) 
                        {
                            ?>
                            <option value="<?php echo $province['id']; ?>"><?php echo $province['name']; ?></option>
                            <?php
                        }
                        ?>
						</select>
					</td>
				</tr>
				<tr>
					<td>
						Email:
					</td>
					<td>
						<input type="text" id="txt_email" name="txt_email">
					</td>
				</tr>
				<tr>
					<td>
						Số điện thoại:
					</td>
					<td>
						<input type="text" id="txt_phone" name="txt_phone">
					</td>
				</tr>
			</table>
			</fieldset>
			<fieldset>
			<legend>Các Thông Tin Khác</legend>
			<table border="0">
				<tr>
					<td>
						Họ và tên:
					</td>
					<td>
						<input type="text" id="txt_fullname" name="txt_fullname">
					</td>
				</tr>
				<tr>
					<td>
						Ngày sinh:
					</td>
					<td>
						<input type="text" id="txt_dayofbirth" name="txt_dayofbirth" size="1" maxlength="2"> / 
						<input type="text" id="txt_monthofbirth" name="txt_monthofbirth" size="1" maxlength="2"> / 
						<input type="text" id="txt_yearofbirth" name="txt_yearofbirth" size="2" maxlength="4">
					</td>
				</tr>
				<tr>
					<td>
						Nghề nghiệp:
					</td>
					<td>
						<input type="text" id="txt_job" name="txt_job">
					</td>
				</tr>
				<tr>
					<td>
                        Tình trạng: 
					</td>
					<td>
						<input type="radio" id="status" name="status" value="single">Độc thân    
						<input type="radio" id="status" name="status" value="marriage">Đã có gia đình
					</td>
				</tr>
			</table>
			</fieldset>
			<div>
				<input type="checkbox" value="agreement"> Đồng ý với các điều khoản
			</div>
			<div align="center">
				<input type="submit" id="bt_signup" name="bt_signup" value="Đăng ký">
				<input type="button" id="bt_cancel" name="bt_cancel" value="Hủy">
			</div>
		</form>
	  </div>
    </div>
<div class="clear"></div>
</div>